- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $109.65 / $223.87
| Facility | | $45.71 | $109.65 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $63.10
| Professional | | $19.95 | $26.30 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $107.15
| Facility | | $47.86 | $77.62 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $54.95
| Professional | | $20.42 | $33.11 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $66.07 / $75.86
| Professional | | $60.26 | $66.07 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $75.86 / $194.98
| Facility | | $29.51 | $75.86 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $69.18
| Professional | | $25.70 | $33.88 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $60.26
| Facility | | $29.51 | $29.51 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $33.88
| Professional | | $29.51 | $29.51 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $40.74 / $89.13
| Facility | | $26.92 | $40.74 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $79.43
| Professional | | $29.51 | $33.11 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $89.13 / $123.03
| Facility | | $44.67 | $89.13 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $35.48
| Professional | | $22.39 | $26.92 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $35.48 / $47.86
| Facility | | $18.62 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $16.98 / $41.69
| Professional | | $12.30 | $16.98 | $41.69 |